前瞻性加拿大胃食管癌症数据库：我们学到了什么？

A prospective Canadian gastroesophageal cancer database: What have we learned?

机构信息

From the Department of Surgery, University of Alberta, Edmonton, Alta. (Purich, Skubleny, Bédard, Stewart, Johnson, Haase, McCall, Schiller); the Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta. (Purich, Skubleny, Ghosh, Bédard, Stewart, Johnson, Haase, McCall, Schiller); and the Department of Oncology, University of Alberta, Edmonton, Alta. (Ghosh)

出版信息

Can J Surg. 2023 Aug 8;66(4):E422-E431. doi: 10.1503/cjs.005122. Print 2023 Jul-Aug.

DOI:10.1503/cjs.005122

PMID:37553256

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10414783/

Abstract

BACKGROUND

Minimal literature exists on outcomes for Canadian patients with gastroesophageal adenocarcinoma (GEA). The objective of our study was to establish a prospective clinical database to evaluate demographic characteristics, presentation and outcomes of patients with GEA.

METHODS

Patients diagnosed with GEA were recruited from Jan. 30, 2017, to Aug. 30, 2020. Data collected included demographic characteristics, presentation, treatment and survival. A multivariable model for overall survival in patients treated with curative intent was created using sex, lymph node status, resection margin status, age and tumour location as variables.

RESULTS

A total of 122 patients with adenocarcinoma of the stomach or gastroesophageal junction were included. Median age was 65 years (interquartile range [IQR] 59-74), 70% of patients were male and 26% were born outside of Canada. Median follow-up time was 14.5 (IQR 8.0-31.0) months. Following staging computed tomography scanning, 88% of patients were deemed to have potentially resectable disease. Eighty-one (76%) received staging laparoscopy and 74 (61%) were treated with curativeintent surgery. Forty-six (62%) patients had nodal metastases. The median number of nodes harvested was 22 (IQR 18-30). The R0 resection margin rate was 82%. The 3-year overall survival for patients who received curative-intent treatment was 63% and 38% for all patients. On multivariable analysis, female sex (hazard ratio [HR] 3.88, = 0.01), positive nodal status (HR 3.58, = 0.02), positive margins (HR 3.11, = 0.03) and tumour location (HR 3.00, = 0.03) were associated with decreased overall survival.

CONCLUSION

Many of the patients with GEA in this study presented with advanced disease, and only 61% were offered curative-intent surgery. A prospective multicentre national GEA database is now being established.

摘要

背景

加拿大胃食管腺癌 (GEA) 患者的结局相关文献较少。本研究的目的是建立一个前瞻性临床数据库，以评估 GEA 患者的人口统计学特征、表现和结局。

方法

2017 年 1 月 30 日至 2020 年 8 月 30 日期间，招募诊断为 GEA 的患者。收集的数据包括人口统计学特征、表现、治疗和生存情况。使用性别、淋巴结状态、切缘状态、年龄和肿瘤位置作为变量，为接受根治性治疗的患者建立总生存的多变量模型。

结果

共纳入 122 例胃或胃食管交界处腺癌患者。中位年龄为 65 岁（四分位距 [IQR] 59-74），70%为男性，26%出生在加拿大以外。中位随访时间为 14.5（IQR 8.0-31.0）个月。在进行分期 CT 扫描后，88%的患者被认为具有潜在可切除性疾病。81 例（76%）接受了分期腹腔镜检查，74 例（61%）接受了根治性手术治疗。46 例（62%）患者有淋巴结转移。切除的淋巴结中位数为 22（IQR 18-30）个。R0 切缘率为 82%。接受根治性治疗的患者 3 年总生存率为 63%，所有患者的 3 年总生存率为 38%。多变量分析显示，女性（危险比 [HR] 3.88， = 0.01）、阳性淋巴结状态（HR 3.58， = 0.02）、阳性切缘（HR 3.11， = 0.03）和肿瘤位置（HR 3.00， = 0.03）与总生存时间缩短相关。